Total Artificial Heart What to Expect

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If you are not already in the hospital, you will probably spend at least a week there to get ready for total artificial heart surgery. You will continue to take any heart medicines prescribed by your healthcare provider. You will also learn about the total artificial heart that you will get and how to protect and care for it.

You will meet with doctors who specialize in the heart, including cardiologists and cardiac surgeons. You will get important information, such as how to prepare for your surgery and what to expect after. Ask your healthcare provider to show you what the total artificial heart device looks like and how it will be placed in your body.

Your providers will order tests to make sure that your body is strong enough for surgery.

• Blood tests can determine your blood type in case you need blood during surgery, and also to check how well your liver and kidneys are working
• Chest imaging tests can take pictures of your heart, lungs, and the inside of your chest to make sure that the total artificial heart, which is large, will fit
• Heart tests, such as an electrocardiogram (EKG), to monitor your heart’s rhythm, and imaging tests to show how well blood is moving through your heart and blood vessels
• Lung function tests to measure how well your lungs work and to help determine if you may need a ventilator after the surgery

Some people also receive extra nutrition through a feeding tube before receiving a total artificial heart.

The surgery to connect the total artificial heart is complicated and can last from five to nine hours.

The surgical team

As many as 15 people may be in the operating room during the surgery.

• Surgeons perform the operation.
• Surgical nurses assist the surgeons.
• Anesthesiologists give you medicine that makes you sleep during the surgery.
• Specialists called perfusionists oversee the heart-lung bypass machine that keeps blood flowing through your body while the total artificial heart is placed in your chest.
• Engineers put together the total artificial heart and make sure that it is working well.

Implanting the total artificial heart

Placing the total artificial heart in your body and starting the heart pump is a multi-step process.

1. An anesthesiologist gives you medicine to make you sleep during the surgery. They also monitor your heart rate, blood pressure, oxygen levels, and breathing throughout the procedure.
2. A breathing tube is placed in your windpipe through your mouth. This tube is connected to a ventilator machine that supports your breathing during the surgery.
3. The surgeon makes a cut into the chest bone and opens the sternum, a long, flat bone in the center of the chest.
4. The surgeons give you medicines to stop your heart so they can operate on it while it is not moving. A heart-lung bypass machine keeps oxygen-rich blood moving through your body during the surgery.
5. The surgeon removes the heart’s ventricles and the total artificial heart is attached to the upper chambers of the heart, then connected to the aorta and the pulmonary artery.
6. After the total artificial heart is attached, the surgical team turns off the heart-lung bypass machine and starts the total artificial heart pump.
7. The chest is usually left open for a day after surgery. If the total artificial heart works properly and there is no unusual bleeding, the surgeon closes the chest.
8. Once additional tests confirm that everything is working as it should, the chest is fully closed. Parts of the heart not removed are clearly marked and the chest is closed in a way that it can be reopened more easily when it is time for a heart transplant.

A hospital stay after total artificial heart surgery may last a month or more. The time it takes to recover from the procedure depends on how healthy the person was before the surgery.

After surgery, you will first recover in the intensive care unit. Your chest and abdomen may be sore or painful – your healthcare provider will give you medicines to treat your pain. A ventilator may still be needed to help with breathing. For a while, fluids and nutrition may be given through a feeding tube or an intravenous (IV) line in the arm. Healthcare providers watch another IV line in the neck or leg to see how well the total artificial heart is working. A tube is also inserted into the urinary tract to drain urine and to check how the kidneys are working.

A few days or more after surgery, you may be moved to a regular hospital room. Nurses who have experience with total artificial hearts and similar devices are in charge of your recovery. They help with sitting, getting out of bed, and walking around. Most people can get up and move around after two weeks. Nurses and physical therapists help with exercises to regain strength by slowly adding activity.

Hospital staff remove feeding, IV, and urine tubes as you get stronger. Eating regular food, going to the bathroom on your own, and taking a shower are all signs that recovery is progressing. This recovery period is also used to teach you how to care for the total artificial heart at home.

During recovery time in the hospital, your family or friends can also learn how to care for the total artificial heart so that they can help with the rest of the recovery at home.

Possible surgery-related complications

Surgery to receive a total artificial heart, as with any surgery, has some risks of complications, including blood clots, bleeding, infection, and death.

Blood clots

Blood may clot more easily because it comes in contact with the machine-made parts of the total artificial heart. Blood clots can block blood vessels that deliver oxygen to important organs in your body. They can cause serious complications such as a stroke, pulmonary embolism, or death. People with total artificial hearts take anticlotting medicines for as long as they have the device.

Bleeding

The surgery to connect a total artificial heart is very complex. Bleeding can occur in the chest during and after the surgery. Anticlotting medicine also raises the risk of bleeding because it thins the blood.

Infection

After surgery, there is a higher risk of infection, so your healthcare provider may give you medicine to lower this risk. You will be watched closely for fever or other signs of infection.

Death

During total artificial heart surgery, as in any major surgery, there is a risk of death. This could be from the procedure, or your body could react poorly to the anesthesia medicines used to help you sleep during the procedure.

Other risks and complications of a total artificial heart

A total artificial heart may prolong your life until a donor heart for transplant becomes available.

Between 60 and 80 percent of total artificial heart recipients live long enough to receive a heart transplant. However, if they do not receive a heart transplant, less than 60% of people with a total artificial heart survive for one year after surgery.

In addition to the risks that come with heart surgery, there are some additional things to know about complications that can arise after you receive a total artificial heart.

• Kidney infection and failure develop more often in people with a total artificial heart than in those who have ventricular assist devices.
• Quality of life may be affected by the need for frequent changes to and charging of the home-based driver. Likewise, hospital-based total artificial heart drivers are large and loud.